Janelle had overdosed 32 times.
Fentanyl coursed through her veins as she was given naloxone (Narcan) for the 32nd time in the ER, from the police, from a bystander. She could never get off of fentanyl. It had made her feel warm and numbed her from the trauma and horrors she had grown accustomed to. When she would wake up in the hospital, sore and discombobulated, she would beg for help. She would beg to make the daily cycle stop of her getting enough money to get her fentanyl to stave off withdrawal and pain. She didn’t use anymore to feel high – she hadn’t felt high in forever. She had tried getting on Suboxone before, many times, with the help of trained professionals. Suboxone is a combination of 2 drugs: buprenorphine and naloxone. This drug sits on the same receptors that heroin, morphine, and fentanyl does and blocks drug cravings.
However, before your first dose of Suboxone, you cannot have any opioids in your system for a minimum of 12 hours, or else you risk throwing yourself into painful withdrawal. In withdrawal, your heart beats out of your chest, you can’t leave the toilet, and you want to crawl out of your skin. It’s a brutal two days that often is cited as one of the main reasons addicted persons continue to use.
But Janelle could never make it through the 12 hours needed to be off of opioids to start Suboxone. And really, because she was using fentanyl, a drug that globs onto our fat and sticks around for a while, she really needed to wait 24 hours to flush the fentanyl out of her system. She couldn’t do it. Her addiction had her in a death grip.
Introduce the Butrans (buprenorphine) patch. This is a formulation of Suboxone that comes in a patch that releases the active ingredient of Suboxone slowly over time. Currently, this transdermal patch is only FDA-approved for pain control. It is not approved to treat opioid use disorder (unlike the approved formulations of Suboxone sublingual films, tablets and injections).
One day, Janelle bought a Butrans patch on the street and taped it onto her emaciated arm – for the first time in her life, she did not use fentanyl. With this specific formulation of buprenorphine and this formulation only, it allowed the buprenorphine to slowly and gently take over her opioid receptors. She no longer craved the drug she had been so dependent on, and she didn’t get thrown into rip-roaring withdrawal. This was the first time she had been off of fentanyl in over ten years.
We need to make the Butrans patch FDA-approved for opioid use disorder to reach our most vulnerable addicts. Those who physically cannot be without opioids for more than 12 hours and who have failed multiple inductions to get onto Suboxone films or tablets. When someone is not protected by medication-assisted treatment, there continues to be an extraordinarily high likelihood of a fatal overdose. A chance for a mother, sister, brother to be found behind a dumpster in the morning, needle still in his or her hand. These people never get to recover from their illness.
Janelle didn’t overdose again because she had the Butrans patch on.
Cara Zimmerman is an internal medicine resident.
Image credit: Shutterstock.com
